Complex Diagnoses: How Neurosurgeons and Neurologists Work Together

Penn Medicine Dr. Ali and Dr. KimbarisGrace Kimbaris, MD, neurologist at Penn Medicine remembers a patient she had who was complaining of pain and numbness in his legs. The symptoms could have been due to a number of causes, like lumbar stenosis or a slipped disk.

Dr. Kimbaris discussed the case with Zarina Ali, MD, a neurosurgeon with whom she works closely at Penn. After examining the patient and reviewing the MRI findings, Dr. Ali recognized that the symptoms were not typical for lumbar stenosis or a herniated disk. She and Dr. Kimbaris continued to investigate the cause of the symptoms.

Ultimately, the patient turned out to have peripheral neuropathy. Once this was diagnosed, the surgery was deferred. He underwent further testing for neuropathy, and was treated for that instead of lumbar stenosis. Because of the joint care that he received by both a neurologist and a neurosurgeon, the patient was able to have a clear diagnosis and management plan.

On the other hand, both physicians recall countless times where surgery was necessary, and highly beneficial.

“Surgery can be the best option in select cases, and it can greatly improve a patient’s quality of life,” says Dr. Ali.

But that doesn’t mean that surgery is always the first course of action. Physicians from the two departments (neurology and neurosurgery) routinely consult each other on challenging cases—especially where the decision to do surgery isn’t a clear-cut case.

Dr. Kimbaris says, “Neurology is a complex topic. While surgery may be the best option, we don’t want to rush right into it. By working together, we can decide if surgery is the right treatment, or if the symptoms are actually due to an alternative diagnosis that can be treated more conservatively. It’s important to have all the parties weigh in.”

Care tailored to the patient

If you go to Penn Medicine for a neurological problem, will your neurologist consult with a neurosurgeon? He or she might. But it depends on your case.

“Some neurological conditions don’t need surgery, and may be treated by a neurologist only,” Dr. Ali says.

“But other conditions—tumors, peripheral nerve compression, degenerative diseases—have very good treatment options that involve surgery. And that’s when the neurosurgeon steps in.”

Even if surgery is not in the stars for you, your neurologist still might consult with a neurosurgeon for an opinion. Why? It’s a smart approach to practicing medicine.

Whenever you find out that you have a brain or spine condition, it’s frankly a great idea to get a second opinion. It gives you confidence that you’ve been given the correct diagnosis, will get the right treatment, and have the best possible outcome.

Collaboration between the neurologist and neurosurgeon provides the same benefit.

“There’s experience and knowledge that we each bring to the table,” Dr. Ali says. “Diagnosis and treatment plans require a thoughtful, rational approach to understanding the problem.”

Dr. Kimbaris’s diagnostic expertise, coupled with Dr. Ali’s clinical and surgical experience, help them decide which treatment plan is best.

Your physician might recommend surgery right away, or you might get a more conservative treatment plan like physical therapy, with surgery as an option down the road.

“When we work as one, we are confident that we’re giving the best diagnosis and treatment recommendations,” Dr. Ali says.

Getting out of the grey areas

There’s another good reason Dr. Kimbaris and Dr. Ali may collaborate on your treatment: They need to decide if your neurological problems are likely to be alleviated by surgery.

Dr. Kimbaris Neurologist

Grace Kimbaris, MD, Neurologist, Penn Medicine

Close is key

At Penn, the neurologists and neurosurgeons work in the same building, which is also beneficial for patients.

“It improves compliance—when patients cooperate with their diagnosis and treatment plan,” Dr. Kimbaris says. “Even the step of having to go to another building at another time could be a reason that patients decide not to follow up or get treatment.”

According to Dr. Kimbaris, being in the same building also helps in several other ways:

● Real-time feedback: There’s no need for physicians to keep emailing back and forth, so nothing gets lost in the shuffle.
● Scheduling convenience: If a patient needs to make appointments with both physicians, he or she can make them back-to-back, on the same day. 
● Avoiding unnecessary trips: The neurologist might not be sure whether the patient needs to be referred to a surgeon or another type of specialist. Being in the same building allows the neurologist to get a quick consult, so she doesn’t waste time sending a patient to the wrong person.

Having both of us in the same building makes things much easier and smoother for patients,” says Dr. Kimbaris. “Better delivery of care is part of the high standards we set for ourselves as medical professionals at Penn Medicine.”

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